How are implants done?

The implant itself is only one of three components necessary to replace a single tooth. 

• The implant is placed into the bone, either when a natural tooth is extracted, or at a later date.  During this procedure, the dentist cuts the gums and exposes the boney ridge.  He drills a hole in the bone the exact size of the implant he plans to use, and then inserts the implant into the hole.  Quite often, it is necessary for the dentist to fill in bony defects with  demineralized bone grafting material.  After the implant is firmly in position, and any bony defects are corrected with bone graft material, the dentist then firmly sutures (sews) the gums over the implant and graft material.  The patient is sent home, and the surgical site is allowed to heal for between 4 and 6 months.  During this time, the implant attaches directly to the bone (a process called osseointegration), and the demineralized bone graft material is replaced with the patient's own bone. 
  
• There is little or no pain associated with actually placing the implant.  Most people are surprised to learn that the bone itself has no nerve endings. Only the gums and the periosteum (the thin sheet of tissue covering the bone's surface) have feeling and need to be numb.  The procedure is done giving shots only around the site of the operation itself.
  
• The bone used in many medical bone grafting procedures is treated bovine (cow) bone.  The bone is stripped of all protein and organic components and thoroughly sterilized before being packaged.  Once processed, the bone contains no trace of its origins, and the human body treats it like its own tissues.  When placed in a bony defect, the patient's immune system begins to resorb (remove) the original graft material and replaces it with his or her own bone.  This process takes between 4 and 6 months. Another type of commonly used bone graft is an artificial material which contains small, hollow, porous spheres of plastic coated with calcium hydroxyapetite. This type of graft is called an alloplastic graft.  The calcium coating encourages bone growth into the plastic spheres which are incorporated into the newly forming boney matrix in the socket.  For more information on bone grafting, click on the toothless skull above.
• Between 4 and 6 months after placing the implant, when healing is complete and the implant is totally osseointegrated, the dentist then does a second minor surgery to uncover the implant.  This is done with only minimal local anesthesia.  Once the implant is uncovered, the dentist then places an abutment into the implant.  The abutment is attached to the implant with a tiny screw which is twisted into place with a special torque wrench.  The dentist then modifies the shape of the abutment so that it will properly fit into the eventual crown.
• Finally, the dentist takes a standard impression, the same as he or she would when fabricating a crown on a natural tooth.  This is sent to the lab which returns a porcelain crown which is cemented over the prepared implant abutment.